Healthcare Provider Details

I. General information

NPI: 1669184602
Provider Name (Legal Business Name): ELENA IVANOVNA NECHEPURENKO PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2022
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 SHUMAN AVE STE 6
AUGUSTA ME
04330-6020
US

IV. Provider business mailing address

12 SHUMAN AVE STE 6
AUGUSTA ME
04330-6020
US

V. Phone/Fax

Practice location:
  • Phone: 207-307-0958
  • Fax: 207-307-0958
Mailing address:
  • Phone: 207-307-0958
  • Fax: 207-512-5909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP221392
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: